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Date � y � <br />^;olication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />owner <br />PUEIit Worka Parmit • <br />em9. oeo�. • ��� 5.� 02 b <br />PWIicWorksFea s <br />Tolel Fee <br />Less Appl Foe Pa10 S <br />Balance Dve 5 <br />�YYI�, <br />Applicant MailingAddress City Zip Phone <br />Describe Proposed Work �,)IAI I/'� QT Q�� <br />J ' <br />Projecl Address (it known) <br />Attach tour (4) copies of plans lor proposed work - Draw to scale and note Ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading clianges <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•SBi b. <br />2. All work shall 6e perlormed in accordance with ihis permit and current City oi Everett Design and Construction <br />Standards and SpeGfications <br />3. Call Location Underground Service AB hrs. belore you di�. TOLL FREE NUMBER 1•800•424•5555. <br />/UC� / ',%�G/G �c.�0 �S �'-;r_-'iri% <br />� �'��C�/�F1� �G-.� <br />� �,^. <br />�4- s �,_ � <br />i%Lh.�Gt�aM�Lr��L�Z�-.-C�..x�r�/ %i,,- •G�.i.'«%.�-' <br />„ � . ,�,�: . <br />�L� i'�� �= r.,�,� ��i� r/� i a�2 �3 l�' ,.c�.c: �: y Ct.���� z7`- <br />/. � <br />Approved for Consiruclion Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />Tlie undersigned owner/applicant hereby agrees to hold and save harm- <br />iess Ihe City ol Everelt Irom any and all claims for damages, costs, <br />ezpenses, or causes ol action ihal may arise because ol installation <br />and maintenance of the improvement or olher righhof-way use herelo <br />applied lor and further agrees to remove same upori nntice Irom the <br />City and to replace public property damageA thereby. <br />Siqnature ol Applicanl Ua�e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE �TARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERcAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br />C�NCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9J DAYS DURATION. <br />